Active NPI
Traci Renee Manry, LPC
- Professional Counselor
- Peoria, AZ
National Provider Identifier
1003429937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC19276
- Practice address
- 15396 N 83Rd Ave Ste G103
Peoria, AZ 85381-5629 - Phone
- (925) 709-4044
- Fax
- (925) 709-4044
- NPI assigned
- Aug 29, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC19276 | Primary | |
| Professional Counselor | 101YP2500X | LAC-17108 | AZ |
Addresses
Primary practice location
15396 N 83Rd Ave Ste G103
Peoria, AZ 85381-5629
Mailing address
15396 N 83Rd Ave Ste G103
Peoria, AZ 85381-5629
Phone (925) 709-4044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAC-17108 | AZ | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transitions Counseling and Consulting | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Glendale, AZ
- NPI 1326414889
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682899200000",
"number": "1003429937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15396 N 83RD AVE STE G103",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853815629",
"telephone_number": "925-709-4044",
"fax_number": "480-247-4179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15396 N 83RD AVE STE G103",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853815629",
"telephone_number": "925-709-4044",
"fax_number": "925-709-4044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANRY",
"first_name": "TRACI",
"middle_name": "RENEE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-29",
"last_updated": "2023-05-01",
"certification_date": "2023-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": "LPC19276",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LAC-17108",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.